In determining whether the conditions for reopening and revising a final determination or administrative law judge (ALJ) decision are met, the ALJ will compute the time between:

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  The date of the notice of the initial determination on the application the ALJ is considering reopening; and

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  The date of the claimant's request for reopening or the date the Social Security Administration takes action to reopen the determination or decision.

The date of the request for reopening will vary from case to case depending on the circumstances, including whether the claimant's request is express or implied (see Hearings, Appeals and Litigation Law (HALLEX) manual HA 01290.010), or whether the ALJ is the person raising a reopening issue. To illustrate, consider the following common examples:

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  If the claimant raises the issue of reopening in a new application (express or implied), the date of the request for reopening is the filing date of the new application. For example, reopening is an issue implied in the application if the claimant alleges an onset of disability during a previously adjudicated time period.

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  If the ALJ is the first person to identify the reopening issue, and he or she would like to reopen on his or her own initiative, the ALJ computes the time period for reopening from the date he or she identified the issue.

Under limited circumstances, an ALJ may reopen multiple prior determinations or decisions. The ALJ will use the same criteria in subsection A above to compute the time period for reopening any earlier determination or decision.

Example:

The claimant filed an application for disability insurance benefits (DIB) on December 13, 2002, alleging that he became disabled on November 4, 2001. The application was denied initially on February 12, 2003, and again upon reconsideration on April 12, 2003. The claimant did not appeal the determination.

The claimant filed a second application for DIB on February 10, 2006, alleging that he had been disabled since November 4, 2001. This application was denied initially on April 15, 2006, and was denied upon reconsideration on June 13, 2006. The claimant did not appeal the determination.

The claimant filed a third application for DIB on September 23, 2009, alleging disability since November 4, 2001. He submits evidence that establishes he has been disabled since November 4, 2001.

Assuming none of the “reopening at any time” criteria are met, the ALJ must reopen the second application because the notice of the initial determination on the second application (April 15, 2006) was within 4 years of the filing date of the application currently before the ALJ (September 23, 2009). However, the ALJ cannot reopen the final determination on the first application because the filing date of the current application (September 23, 2009) was not within four years of the date of the notice of the initial determination on the first application (February 12, 2003).

In the Fourth Circuit, AR 90-4(4): Culbertson v. Secretary of Health and Human Services provides an expanded timeframe in which certain claimants may request reopening on a prior determination. In short, if the adjudicator determines that mental incompetence prevented the claimant from understanding the procedures for requesting administrative review of a prior determination, and the claimant had no individual who was legally responsible for prosecuting the claim, he or she will not apply res judicata or administrative finality even if more than four years have elapsed in a title II claim or two years in title XVI claim. Rather, the ALJ will reopen the prior determination and issue a revised determination.

The Ninth Circuit also provides an expanded timeframe in which certain claimants may request reopening. AR 92-7(9): Gonzalez v. Sullivan applies only to claimants in the Ninth Circuit who received an adverse initial determination prior to July 1, 1991 and did not timely appeal that determination. For the purposes of this AR, the time limits for reopening and revising final agency determinations do not apply when the claimant meets the criteria outlined in the AR.

In addition to these ARs, see also Social Security Ruling (SSR) 91-5p, Mental Incapacity and Good Cause for Missing the Deadline to Request Review, when applicable (e.g., the claimant was unrepresented at the time of the prior administrative action), and SSR 95-1p, Policy Interpretation Ruling Title II and Title XVI: Finding Good Cause for Missing the Deadline to Request Administrative Review Due to Statements in the Notice of Initial or Reconsideration Determination Concerning the Right to Request Administrative Review and the Option to File a New Application, as applicable.